Research in Nursing Informatics: Naming, Claiming, & Changing Health Outcomes

1. Research in Nursing Informatics:Naming,Claiming, &ChangingHealth Outcomes Patricia Flatley Brennan,RN, PhD, FAAN University of Wisconsin-Madison Supported by grants from the NIH and the UW-Madison Graduate School School of Nursing University of Wisconsin-Madison

2. Nursing Informatics Diagnosis & treatment of human responses Health Policy Genomics Representation, Transformation, Manipulation & Application of Information Semantics Syntax

3. Knowledge building in health informatics

4. Health Policy & Clinical Practice Health Care System Definition System Evaluation System Construction System Validation Informatics System Description

5. 25 Years of Progress In Nursing Informatics Research Clinical Practice System Evaluation System Definition System Validation System Construction System Description

6. Clinical Practice 2001 System Definition System Evaluation System Validation System Construction System Description ReferenceModels Ontologies Formal Languages Vocabularies ControlledTerms Terms 1976

7. Formalismthat is comprehensible, computable, and translatable R NLP Artifact(e.g. clinical record) Health Care Vocabularies Standardized vocabularies are sufficiently robust to capture most terms needed to describe the problems nurses treat (~ 70%--80%) Bakken (Henry), 1994

8. NANDA NIC NOC HHCC Omaha System ICNP NILT Patient Care Data Set AORN Data Set Nursing terminologiesprovide a rich set of terms to represent nursing concepts BUT lack the grammars and syntax rules, and granularity, needed to support full computerizationHardiker, 1999 Nursing-Specific Terminologies

9. Genomic Data Mining 2001 Bayesian Belief Nets Explanation Clinical Practice System Definition System Evaluation AI, Probability Models and certainty factors System Validation System Construction 1976 System Description Decision Support for Diagnostics & Therapeutics

10. Clinical Decision Support Supports! Patients in a nursing home had fewer wetting events when nurses used UNIS to help plan care Petrucci, 1993

11. Alerts & Reminders Clinical Practice System Definition System Evaluation System Validation System Construction System Description Clinical Information systems Bringing knowledge to the point of care

12. Clinical Information Systems Help Structured assessment and clinical guidelines, integrated in the clinical information system, facilitate compliance

13. Computer screens effect performance Nurses using a graphical interface to manipulate order sets completed tasks faster, and with fewer errors, than when using text entry. Staggers & Kolbus, 2001

14. 35 30 25 20 15 10 5 0 SIP CHIP 0 1 2 3 4 5 6 HeartCare Months Since Surgery Home Telenursing Aids Recovery Access to HeartCare helped patients recovering from CABG surgery to get better, faster.

15. Lessons Learned

16. Where nursing goes, nursing informatics follows and sometimes leads!

17. You’ve got to build it to use it

18. Sometimes a rose by any other name isn’t recognizable

19. Structured data entry helps

20. Decision support works behind the scene

21. Data security wins

22. Patients are Users, too

23. Genes are more than bits of people, andPeople are more than bits of genes

24. We like to work together

27. How does Nursing Informatics Research differ from other NURSING Researchendeavors?

28. Nursing Informatics Research Focus on the structure and manipulation of the data Provides manipulation tools specific to knowledge Emphasizes system acceptability & effect Nursing Research Focus on the substance of the discipline Makes nursing phenomena explicit Develops and tests clinical therapeutics Different Knowledge Products

29. Vision for the Future

30. Health Policy & Clinical Practice Health Care System Definition System Evaluation System Construction System Validation Informatics System Description

31. Health Policy & Clinical Practice Nursing Science CS Health Care System Definition System Evaluation System Construction SystemValidation Informatics HSR System Description

32. Innovative care models with a balance of human and techological resources Development of a full range of nursing practice tools Linking genomic data to genetic information, and then to the patient record and placed in to the patient’s hand Technical solutions to the challenges of privacy and security Natural language and speech recognition The problem lies in creating representation of the context within which the speech is produced and should be interpreted Virtual Human -- genomic functions & anatomy Visionsfor the future

33. Guidance for the Future

34. “ask yourself if the step you contemplate is going to be of any use to the poorest and weakest man whom you have seenWill he gain anything by it?Will it restore him to control over his life and destiny?…then you will find your doubts and yourself melting away” Gandhi,1947

35. …if we can call it nursing to set up the emergency shelter after the dam has burst, isn’t is also nursing to lobby to be sure that the dam never gets made in the first place? Florence Storlie, 1971

36. Acknowledgements • The work of colleagues over the past 50 years • Conversations and debates with many including • AMIA colleagues: Mark Musen, Gil Kuperman, Carol Friedman, Bonnie Kaplan, Charley Safran • UW-Madison colleagues: Rima Apple, Richard Staley, Barbara Bowers, Josette Jones & the Brennan research team • The Moehlman Bascom Professorship • NIH

37. http://healthinfo.engr.wisc.edu pbrennan@engr.wisc.edu